To the Editor.—
Pierce et al (219:1593, 1972) reported lymphomas as a complication of renal transplantation. They stated that in two of their three cases of reticulum cell sarcoma the earliest manifestation of the tumor was a macrocytic anemia which occurred in the presence of maintenance folic acid (PGA) therapy and which, in one case, responded to treatment with folinic acid.Dossetor et al, in 19641 described in one patient the presence of macrocytic anemia and megaloblastic marrow with normal serum levels of vitamin B12 and folate but reduced red blood cell (RBC) folate levels, in the absence of tumor. They commented on the lack of information on azathioprine interfering with vitamin B12 action.In 1965, Mowbray et al2 reported four transplant patients treated with azathioprine, who developed macrocytic megaloblastic anemia. In one patient, an abnormal formiminoglutamic acid excretion after histidine load suggested interference with folic
Roman J, Wheby MS, Atuk NO, Westervelt FB. Anemias With Renal Transplantation. JAMA. 1972;221(11):1283. doi:10.1001/jama.1972.03200240057028
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